This application proposes to continue the current research program designed to identify how interactions among psychosocial risk factors and demographic variables affect the risk for cardiovascular disease (CVD). Hostility, depression, and the social environment (especially socioeconomic status and social support) remain the focal points of interest. New questions will be raised regarding their role in the development and course of CVD. The four studies outlined in this proposal are designed to address new research issues while maintaining commitment to the interactional approach of the original application. Study 1 will conduct a detailed assessment of depressive symptoms and other psychosocial variables in cardiac patients. The origins and nature of age differences in psychological distress will be investigated with special attention to subgroups of depressive symptoms. Hypotheses regarding the role of appraisal processes in patient depression will be tested. The temporal course of depressive symptoms after hospitalization will be described and hypotheses will be tested regarding the factors that influence changes in depressive symptoms over time. Study 2 will investigate the course and determinants of changes in depressive symptoms in another patient sample. It will complement Study 1 with a different battery of measures and repeated follow-ups over a much more extended period. Study 3 will take advantage of existing data from a large longitudinal investigation of CVD to examine vital exhaustion, hopelessness, social isolation, and social conflict as predictors of coronary events. Study 4 will use two existing longitudinal studies to evaluate vital exhaustion, hopelessness, depressive symptoms, social conflict, social isolation, and hostility as predictors of the incidence of stroke. Hypotheses regarding moderating variables and interactions between psychosocial risk factors will be tested in both Studies 3 and 4.